Intravitreal Ranibizumab for Retinal Angiomatous Proliferation

Purpose To assess the efficacy and safety of intravitreal injection of ranibizumab (IVR) in patients with retinal angiomatous proliferation (RAP) Methods 22 eyes of 22 patients with RAP were retrospectively enrolled in the study. Patients were divided into 2 groups depending on prior treatment history: 12 eyes with newly diagnosed RAP, treatment naïve were included in group A, and 10 patients who had undergone previous therapy (intravitreal bevacizumab/triamcinolone acetonide monotherapy or combined with photodynamic therapy) were included in group B. All patients underwent visual acuity (VA) measurement using Snellen charts (converted into LogMAR for statistical analysis), complete ophthalmic examination, fluorescein and indocyanine-green angiography (FA and ICGA), and optical coherence tomography (OCT) at baseline, 3 and 5 months. All patients received three consecutive IVR (0.5 mg) on a monthly basis. The need for additional injections was based on the presence or recurrence of fluorescein leakage, evidence of RAP on ICGA, persistent or recurrent intra/subretinal fluid on OCT, new hemorrhage. Main outcome measures were changes in VA and central retinal thickness (CRT) on OCT. Results Baseline VA was 0.68±0.48 LogMAR (mean±SD) in group A and 0.74±0.33 LogMAR in group B. Eyes in group A exhibited a mean visual improvement of 0.08±0.16 LogMAR (p=0.11) and 0.07±0.19 LogMAR (p=0.25) at 3 and 5 months FU, compared to a mean variation of 0.0±0.27 LogMAR (p=1.0) and 0.01±0.28 LogMAR (p=0.91) in group B. In both groups changes in VA were not significant. Baseline CRT, 398±150 µm and 389±110 µm in group A and B respectively, decreased significantly in both groups (p<0.025), with a mean reduction of 235±165 µm and 152±178 µm (group A), and 229±110 µm and 146±84µm (group B). Three eyes in group A and one in group B were re-treated at 3 months. At 5 months six patients in both groups required an additional IVR. No significant complications, including RPE tears, were noticed. Conclusions Short-term results suggest that intravitreal ranibizumab provides significant anatomical improvement with no significant adverse events in patients with RAP. Visual improvement was not significant at any point during the follow up, even though there was a trend toward stabilization or improvement, especially in treatment naïve patients. A worse response to treatment in group B could be related either to a lower mean VA at baseline and/or to the presence of RPE atrophy/fibrosis induced by previous treatments.